Venture capital executives are interested in funding startups that specialize in Medicaid services despite anticipating total investment in the digital health industry will continue to fall from the highs of 2021.
UnitedHealth Group’s Optum Ventures wants to invest in companies that specialize in Medicaid or caring for other complex populations, Laura Veroneau, managing partner, said during a panel at the HLTH conference Monday. The venture capital firm is also interested in funding companies whose founders understand how to handle the challenging Medicare Advantage regulatory market, she said.
“Regulation is a reality of doing business in healthcare,” Veroneau said. “You see these different moments where rules more or less are changed, and in those changing moments those that can adapt and adjust their business models create pretty great business models.”
Optum Ventures is “a little slower” to buy into investor hype surrounding artificial intelligence than others, she said.
Venture capital firm Oak HC/FT is also interested in investing in the Medicaid space, Andrew Adams, co-founder and managing director, said during the panel discussion. Incumbent payers and providers are weighing the cost of acquiring digital health companies versus building them themselves, and more are choosing to construct the services in-house, Adams said.
“Ultimately, how will [an incumbent] value this company? Maybe they will think, ‘I’ll build it myself because I’m not going to pay X hundreds of millions.’ At the moment, I think we’re in that period and it’s getting worked out right now. I think it’s probably going to be painful.”
6:15 p.m. CT: Highmark partners with Spring Health
Highmark Health will partner with digital behavioral health provider Spring Health in January 2024, the companies announced in a news release Monday.
Highmark’s health plans’ 2.8 million small group, exchange and Medicare Advantage members will have access to Spring Health services, Dr. Anil Singh, Highmark Health senior vice president and executive medical director of population and curated health, said during a HLTH conference panel Monday.
Enrollees will be able to request an appointment with a Spring Health provider through Highmark’s app. Members will be able to schedule an in-person or virtual appointment within three days, Singh said.
“What we don’t want is to have a bunch of apps on people’s phones, where they have to go and search and find and so forth,” Singh said. “Allowing us to have a single front door that leads to a single access point, that’s one of the differentiators that we have.”
Singh declined to disclose the financial terms of the deal.
The Highmark partnership represents the first time Spring Health has integrated into an insurer’s technology system, Kelly Morrison, vice president of health plans and channel partnerships at the company, said during the HLTH panel. Spring Health works with 4,000 employers that range in size from startups to Fortune 500 companies, she said. The company counts thousands of psychiatrists and other behavioral health providers in its network who specialize in virtual and in-person care for children and adults, Morrison said.
5:30 p.m. CT: Teladoc partners with virtual physical therapy companies
Teladoc Health is working with two virtual physical therapy companies, Sword Health and Hinge Health, to increase its offerings for employer customers. Teladoc has entered into reseller agreements with each company, which give those customers access to services at both organizations.
Kelly Bliss, Teladoc’s president of U.S. group health, said the arrangements will allow employers to streamline some of the administrative tasks they face when launching a new health solution vendor. She said the collaborations will also help combat point solution fatigue among employers.
“There is vendor fatigue and point solution madness … over the costs associated with having multiple point solutions, maintaining the infrastructure to do that … and the excessive investment required to ensure that [these solutions] are all getting off the ground, and people are actually utilizing those services,” Bliss said.
About 75% of Teladoc’s sales are for two products, Bliss said. She said macroeconomic challenges have pushed employers in this direction.
Teladoc did not share financial terms of the agreements.
4 p.m. CT: Google adds generative AI search for clinical settings
Google’s cloud arm is adding a generative artificial intelligence search function for healthcare and life science organizations, the company announced at HLTH on Monday.
Google Cloud said its Vertex AI search capabilities are being tuned for healthcare organizations, which will allow clinicians to search for specific information directly in electronic health records and other clinical systems. Read the full story.
12:45 p.m. CT: Nemours invests in AI as it faces more prior authorization demands, payment denials
Insurers are increasing their prior authorization requirements and delaying and denying more payments to Nemours Children’s Health, CEO Dr. Larry Moss said during an interview at the HLTH conference Monday.
“We’re seeing a lot of that. Ultimately we’re winning 99% of disputes, but they’re sucking a lot of emotional and intellectual energy out of the organization,” Moss said. “We might win, but a lot of people spend a lot of time squabbling over a particular claim.”
The Jacksonville, Florida-based academic medical system, which operates two hospitals and 70 outpatient facilities across six states, is working to automate as many of its claims processes as possible in response to rising demands by insurers, Moss said.
“We’re trying to get more savvy in our billing and claims processes and, like many of our peers, we’re using [artificial intelligence] and advanced technology,” he said. “Claims administration is the area where human touch is maybe not as valuable to the patient as it is at the bedside.”
Nemours is also lobbying the Centers for Medicare and Medicaid Services and state Medicaid agencies for increased payment and more risk-based payment models, Moss said. The health system has also partnered with 14 social services agencies to address issues related to social determinants of health and invested $100 million over the past five years to create a population health services organization.—Nona Tepper